Ever since the Governor unilaterally privatized Medicaid in April 2016, the results have been disastrous for Iowa. Iowan’s have been denied critical care, had their services drastically reduced or cut, and in some extreme cases, people have died from lack of care. However, last week small steps were taken to lessen the impact that privatization has had on our most vulnerable population.


A bipartisan bill that passed the House changed some provider processes, updated member services and created more Medicaid oversight. The biggest provisions in the bill include using standardized Medicaid provider enrollment forms and credentialing standards to lessen the confusion for those providers entering into contracts with the managed care organizations (MCOs). The bill directs that if a payment error is found, the MCO has to fully and correctly reprocess the claim and correct the system within 90 days, and directs the Department of Human Services (DHS) to both review and approve when a MCO reduces a member’s level of care. This bill also forces the MCOs to provide and pay for five days of services and treatment if a member is court-ordered to receive the services. This provision will help members who are in crisis, or have substance-abuse related issues to get the initial services they need without worrying if the treatment will be covered.


Finally, several oversight provisions were added. The bill directs DHS to create a workgroup to review health home programs, initiates a review process of prior authorizations by the MCOs, and guides DHS to hire an independent auditor to perform an audit of small dollar ($2,500 or less) claims paid or denied to Medicaid long-term services and supports providers.


Even though this is a good first step in addressing some of the problems of privatized Medicaid, there is still a lot of work to be done. MCOs are still businesses, and their first priority is to make profits-not take care of Iowans.


HF 2462 now goes to the Senate for consideration.